Author Interviews, JAMA, Obstructive Sleep Apnea, Sleep Disorders / 27.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31527" align="alignleft" width="133"]Dr. Alex Krist, MD MPH Task Force member Associate Professor Fairfax Family Medicine Residency Co-director, Ambulatory Care Outcomes Research Network Virginia Commonwealth University Dr. Alex Krist[/caption] Dr. Alex Krist, MD MPH Task Force member Associate Professor Fairfax Family Medicine Residency Co-director, Ambulatory Care Outcomes Research Network Virginia Commonwealth University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea.
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, University of Pittsburgh / 26.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31417" align="alignleft" width="100"]Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh. Dr. Yende[/caption] Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh. [caption id="attachment_31418" align="alignleft" width="66"]Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion Dr. Mayr[/caption] Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body's response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs.
Author Interviews, Cancer Research, Colon Cancer, JAMA, Surgical Research / 25.01.2017

MedicalResearch.com Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients.  To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. MedicalResearch.com: What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years.  However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy.
Author Interviews, Diabetes, JAMA, Technology / 23.01.2017

MedicalResearch.com Interview with: Dr Marcus Lind Associate Professor of Diabetology at the University of Gothenburg Gothenburg, Sweden Chief Physician of Diabetology, Uddevalla Hospital Uddevalla, Sweden MedicalResearch.com: What is the background for this study? Response: This was a randomized trial over 16 months (cross-over study with 26 weeks of each treatment and a between wash-out period of 17 weeks) of 161 persons with type 1 diabetes. The main purpose was to evaluate whether a “diabetes tool”, denoted continuous glucose monitoring improves the glycaemic control, known to be essential to lower risks for diabetic complications such as injuries on eyes, kidneys, nerves and the cardiovascular system. The study also evaluated whether the glucose could be stabalised, i.e. having less fluctutations (beside the average level per se) and whether well-being, treatment satisfaction and feeling more confident in the daily living to avoid low glucose values which lead influence the cognitive function and can lead to unconciousness. Earlier trials exist of this therapy in connection to insulin pumps. But it has not been tested in randomized trials with persons only using multiple daily insulin injections to administer insulin which is the most common therapy among adults with type 1 diabetes. Another novelty is that the current CGM-system (DexCom G4) has earlier shown a high accuracy and positive treatment experience among persons with type 1 diabetes, but it has not been tested in long-term randomized trials. Of note this trial was performed among adults with type 1 diabetes. Continuous glucose monitoring (CGM) is a system where the patient has a sensor subcutaneously that he/she easily can change every week. It estimates the glucose level every minute and shows values on a hand-held small monitor (size of a small cell-phone) and whether the glucose levels are rising or declining. The hypothesis with the study is that if the patient has continuous information of the glucose level and trends it will improve treatment variables. The comparison group was that patients got information of their glucose control via capillary finger sticks which has been the general treatment for a long time period but can only be made at certain occasions since a procedure where blood must be taken from the finger tips.
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity / 20.01.2017

MedicalResearch.com Interview with: Fatima Rodriguez, MD, MPH Chief Cardiovascular Medicine Fellow Stanford University MedicalResearch.com: What is the background for this study? Response: Hispanics are the largest minority group in the U.S. Although cardiovascular disease (CVD) is the leading cause of death for Hispanics, most studies exploring disparities focus on Black and White differences. Additionally, Hispanics are often aggregated into one homogenous group, which masks important differences. There is also an interesting epidemiological phenomenon known as the “Hispanic paradox” that states that although Hispanics have greater risk factors for CVD, they experience lower mortality.
Anesthesiology, Author Interviews, JAMA, OBGYNE, Surgical Research / 20.01.2017

MedicalResearch.com Interview with: Adam Sachs MD Assistant Professor of Anesthesiology University of Connecticut School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: When women undergo appendectomy or cholecystectomy during pregnancy they are obviously concerned about the well being of their fetus. Unfortunately, the majority of the data available to council pregnant women is outdated and medical practice has significantly changed since their publication.
Author Interviews, Cost of Health Care, JAMA, Johns Hopkins, Medicare / 17.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31255" align="alignleft" width="150"]Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036 Dr. Ge Bai[/caption] Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated. The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).
Anemia, Author Interviews, Global Health, JAMA, OBGYNE / 17.01.2017

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden MedicalResearch.com Interview with: Dr. Ola Andersson MD, PhD Uppsala University, Uppsala, Sweden MedicalResearch.com: What is the background for this study? Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants. At birth, approximately 1/3 of the child's blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood. Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant. The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.
Author Interviews, Diabetes, JAMA, Schizophrenia / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31233" align="alignleft" width="150"]Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London Dr. Toby Pillinger[/caption] Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our meta-analysis has provided strong evidence that compared with healthy controls, individuals with early schizophrenia are at increased risk of developing type 2 diabetes mellitus, even when the effects of antipsychotic drugs, diet and exercise are taken out of the equation. Schizophrenia is associated with a dramatically reduced life expectancy, with individuals dying up to 30 years earlier than the general population. Approximately 60% of this excess mortality is due to physical health disorders such as heart attack or stroke, for which diabetes is a major risk factor. People with long-term schizophrenia are 3 times more likely than the general population to have diabetes, something that has previously been blamed on poor diet and exercise habits, as well as the use of antipsychotic medication. However, the link between schizophrenia and diabetes was first made back in the 19th century, long before the use of antipsychotics, and in an era where diets were less likely to cause diabetes. This could suggest that there is a causative link between schizophrenia and diabetes. Our meta-analysis examined whether diabetes risk is already raised in people at the onset of schizophrenia, before antipsychotics have been prescribed and before a prolonged period of illness that may be associated with poor diet and sedentary behaviour. We pooled data from 16 studies comprising 731 patients and 614 individuals from the general population. We collated blood data examining fasting blood glucose levels, blood glucose levels following the oral glucose tolerance test, fasting insulin levels and degree of insulin resistance. We demonstrated that compared with healthy controls, individuals with early schizophrenia had raised fasting glucose, raised levels of glucose following the oral glucose tolerance test, raised fasting insulin and elevated insulin resistance. Furthermore, these results remained statistically significant even when we restricted our analyses to studies where individuals with schizophrenia were matched to healthy controls with regards their diet, the amount of exercise they engaged in and their ethnic background. This suggests that our results were not wholly driven by differences in lifestyle factors or ethnicity between the two groups, and may therefore point towards a direct role for schizophrenia in increasing risk of diabetes.
Author Interviews, Biomarkers, JAMA, Prostate Cancer, Radiation Therapy / 13.01.2017

MedicalResearch.com Interview with: Trevor Royce MD MS Resident, Harvard Radiation Oncology Program MedicalResearch.com: What is the background for this study? What are the main findings? Response: Clinical trials in early prostate cancer take more than a decade to report on. Multiple early reporting endpoints have been proposed, but which one is best, remains unknown, until now. Of all the possible early endpoints examined, to date, how low a PSA blood test falls to, after treatment with radiation and hormonal therapy, appears to be the best, specifically, if the PSA doesn’t get below half a point, that patient is very likely to die of prostate cancer if given standard treatment for recurrence. Those men deserve prompt enrollment on clinical trials in order to properly save their life.
Author Interviews, JAMA, OBGYNE, Pediatrics / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31204" align="alignleft" width="141"]Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine Dr. Alex Kemper[/caption] Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine MedicalResearch.com: What is the background for this study? Response: Neural tube defects, where the brain or spinal cord do not develop properly in a baby, can occur early in pregnancy, even before a woman knows she is pregnant. Taking folic acid before and during pregnancy can help protect against neural tube defects. Most women do not get enough folic acid in their diets, so most clinicians recommend that any woman who could become pregnant take a daily folic acid supplement.
Author Interviews, Emergency Care, JAMA, Stroke, Surgical Research / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31220" align="alignleft" width="181"]Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto Dr. Vitor Mendes Pereira[/caption] Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?
Author Interviews, Biomarkers, Critical Care - Intensive Care - ICUs, Infections, JAMA, Pediatrics / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31122" align="alignleft" width="140"]Halden F. Scott MD, Assistant Professor Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine Dr. Halden F. Scott[/caption] Halden F. Scott MD, Assistant Professor Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine MedicalResearch.com: What is the background for this study? Response: Sepsis, a dysregulated immune response to infection, is a leading cause of death for children. Survival depends on rapid diagnosis and timely delivery of life-saving resuscitative care, including fluids and antibiotics. However, it can be challenging to make an early diagnosis of sepsis in children. Millions of children present for emergency care of infection and fever every year, most of whom will not develop sepsis. Tools that assist providers in distinguishing the sickest children with infection at an early stage could enable the early delivery of life-saving treatments. Lactate is a clinically-available laboratory test that has played a critical role in improving the diagnosis and treatment of sepsis in adults. Sepsis may cause lactate levels to rise in the blood during sepsis, through reduced delivery of oxygen to the tissues, as well as through changes in how energy is produced and in how lactate is cleared by the kidney and liver. Data about lactate in pediatric sepsis, particularly early levels and whether it is associated with mortality, have been limited.
Author Interviews, Blood Pressure - Hypertension, Global Health, JAMA / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31158" align="alignleft" width="147"]Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington Dr. Gregory Roth[/caption] Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time. In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased. Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).
Author Interviews, Cost of Health Care, JAMA / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31052" align="alignleft" width="131"]Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 Dr. Joel Segel[/caption] Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 MedicalResearch.com: What is the background for this study? Response: Americans’ health insurance plans increasingly include deductibles, which require patients to pay a certain amount out-of-pocket before the health plan will cover most services. In addition, the levels of these deductibles have been increasing with more and more Americans enrolling in high-deductible health plans (HDHP’s), which in 2013 were plans with a deductible of $1,250 or more for an individual or $2,500 or more for a family. Furthermore, nearly 40% of those with private insurance have a HDHP including most of the bronze and silver plans on the federal Marketplace. This trend has many worried that patients are facing greater financial risk and may delay or forego necessary care because of costs. A population that may be most vulnerable to these problems are Americans with common chronic conditions.
Author Interviews, Global Health, JAMA, OBGYNE, Surgical Research / 09.01.2017

MedicalResearch.com Interview with: Jianmeng Liu, PhD, MD Professor in Epidemiology and Biostatistics Director, Institute of Reproductive and Child Health/key Laboratory of Reproductive Health Ministry of Health Director, Office for National Maternal and Child Health Statistics of China Peking University Health Science Center Beijing, China MedicalResearch.com: What is the background for this study? Response: Cesarean overuse can jeopardize maternal and child health. It has been widely concerned that cesarean rate in China is at an extremely high level. Concerns about “alarming” rates increased after a World Health Organization (WHO) report that 46.2% of births were delivered by cesarean in 2007-2008, based on analysis of deliveries in 21 hospitals of 3 provinces of China. Since 2002, reducing the cesarean rate has been a national priority, and a variety of policies, programs and activities have emerged at both the central and local governments. Previous national estimates of cesarean rates have been based on surveys with limited geographical coverage. Given the marked diversity of geography, economy, and life circumstances throughout China, survey estimates are likely to be sensitive to the area sampled. By analyzing county-level national data on cesarean rates that have been collected since 2008, this study aimed to determine the overall rate and change in rate of cesarean deliveries, examine geographic variation, and, in areas where declines occurred, assess changes in maternal and perinatal mortality.
Author Interviews, Exercise - Fitness, JAMA / 09.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31030" align="alignleft" width="125"]Gary O’Donovan, Ph.D. Research Associate: Exercise as Medicine School of Sport, Exercise and Health Sciences National Centre for Sport and Exercise Medicine Loughborough University Dr. Gary O’Donovan,[/caption] Gary O’Donovan, Ph.D. Research Associate: Exercise as Medicine School of Sport, Exercise and Health Sciences National Centre for Sport and Exercise Medicine Loughborough University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was inspired by the classic Harvard University study of weekend warriors. It was a privilege to work with Professor I-Min Lee, one of the authors of the classic study. Our study was much larger than the classic study. With greater statistical power, we found that, compared with inactive adults, all-cause mortality, cardiovascular disease mortality, and cancer mortality risks were significantly lower in weekend warriors who performed the recommended amount of 150 minutes of moderate or 75 minutes of vigorous activity in one or two sessions per week. Our study extends the classic study by showing that the benefits of the weekend warrior physical activity pattern are much the same in men and women.
Author Interviews, Biomarkers, JAMA, Multiple Sclerosis / 07.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31038" align="alignleft" width="200"]Prof Rogier Q Hintzen Neurologist/immunologist Head MS Centre ErasMS Dept of Neurology Erasmus MC, PB 2040 Rotterdam Prof Rogier Q Hintzen[/caption] Prof Rogier Q Hintzen Neurologist/immunologist Head MS Centre ErasMS Dept of Neurology Erasmus MC, Rotterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Years ago, we identified soluble (s) CD27 as a biomarker for T cell activation in body fluids, as part of my PhD study. (J Immunol. 1991 Jul 1;147(1):29-35.) As we presume the neuropathology seen in MS is guided by T cells we were interested to be able to quantify the activity of such cells in a given patient. Cerebrospinal fluid (CSF) is as close as we can get to the site of the disease process in MS, therefore we focus on biomarkers in this compartment. We found clearly elevated levels of sCD27 in CSF of Multiple Sclerosis patients versus non-inflammatory controls. In this study we investigated whether at the moment of first attack of suspected Multiple Sclerosis, quantification of CSF sCD27 can predict further progression in to a diagnosis of MS and whether sCD27 levels are correlated with later attack frequency. Indeed, we found that high sCD27 measured at this early stage predicts a more rapid diagnosis of Multiple Sclerosis and a more aggressive disease course.
Author Interviews, Cancer Research, JAMA, Orthopedics / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31008" align="alignleft" width="130"]Charles L. Shapiro, MD Professor of Medicine Co-Director of Dubin Breast Center Director of Translational Breast Cancer Research Director of Cancer Survivorship, Tisch Cancer Institute Mount Sinai Health System Division of Hematology / Medical Oncology: Tisch Cancer Institute New York, NY 10029 Dr. Charles Shapiro[/caption] Charles L. Shapiro, MD Professor of Medicine Co-Director of Dubin Breast Center Director of Translational Breast Cancer Research Director of Cancer Survivorship, Tisch Cancer Institute Mount Sinai Health System Division of Hematology / Medical Oncology: Tisch Cancer Institute New York, NY 10029 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Metastases to bone are frequent in many cancers and cause pain, pathological fractures, necessitate surgical and/or radiation treatments, cause spinal chord compression that can lead to paralysis, and significantly increase health care costs. Zoledronic acid, a bisphosphonate that inhibits bone resorption, is used in standard practice because it reduces the risks skeletal-related events including cancer-related pathological fractures, the need for surgery and/or radiation to bone metastases, and spinal chord compression in patients with breast cancer, prostate cancer and multiple myeloma. However, the optimal dosing interval for zoledronic acid is unknown and based on prior studies and empiricism it is administered monthly along with anti-cancer treatments. In this trial, over 1800 breast cancer, prostate cancer and multiple myeloma patients with bone metastases were randomized to the standard dosing interval of monthly zoledronic acid versus every 3-months zoledronic acid for a duration of two years. The results overall, and in each specific disease site, show that giving zoledronic acid once every 3-months as opposed to monthly did not result in any increase in skeletal-related events.
Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30994" align="alignleft" width="180"]MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovatio Dr. Amol Navathe[/caption] Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation MedicalResearch.com: What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
Author Interviews, JAMA, Mental Health Research, Pulmonary Disease / 06.01.2017

MedicalResearch.com Interview with: Meng-Ting Wang, PhD Associate Professor School of Pharmacy National Defense Medical Center Taipei, Taiwan MedicalResearch.com: What is the background for this study? Response: During the past decades, there have been multiple case reports about acute respiratory distress or acute respiratory failure (ARF) from the use of antipsychotics. Nevertheless, no population-based studies have been conducted to examine this potential drug safety issue. We aimed to investigate the association between use of antipsychotics and risk of ARF in a population of chronic obstructive pulmonary disease (COPD), who is vulnerable to ARF and frequently prescribed with antipsychotics.
Author Interviews, Cost of Health Care, Diabetes, JAMA / 05.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30753" align="alignleft" width="125"]Joseph Dieleman, PhD Institute for Health Metrics and Evaluation | University of Washington Seattle, WA 98121 Dr. Joseph Dieleman[/caption] Joseph Dieleman, PhD Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient. In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average. Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3. Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care.
Author Interviews, JAMA, Kidney Disease, Pediatrics / 05.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30892" align="alignleft" width="145"]Jonathan Slaughter, MD, MPH Assistant Professor of Pediatrics Center for Perinatal Research Nationwide Children's Hospital/The Ohio State University Columbus, OH 43205 Dr. Jonathan Slaughter[/caption] Jonathan Slaughter, MD, MPH Assistant Professor of Pediatrics Center for Perinatal Research Nationwide Children's Hospital/The Ohio State University Columbus, OH 43205 MedicalResearch.com: What are the main findings? Response: The ductus arteriosus, a fetal blood vessel that limits blood flow through the lungs, normally closes shortly after birth. However, the ductus often remains open in premature infants, leading to patent ductus arteriosus (PDA). Infants with PDA are more likely to die or develop bronchopulmonary dysplasia (BPD), the major chronic lung disease of preterm infants. Nonsteroidal Anti-inflammatory Drug (NSAID) treatment has been shown to close PDAs in preterm infants and NSAID treatment of PDA is common. However, it has never been shown that PDA closure with NSAIDs leads to decreased mortality or improved long-term respiratory outcomes. NSAID closure of PDA has become increasingly controversial in recent years since NSAID treatment has been associated with acute renal injury. Also, these medications are expensive, with the usual three-dose treatment course costing well over $1000 per patient. Due to these controversies, the likelihood of a preterm infant with PDA being treated with NSAIDs varies by clinician and institution and has decreased over time. Meta-analyses of randomized trials that investigated NSAID (indomethacin and/or ibuprofen) treatment for PDA closure in preterm infants did not show a benefit. However, they were principally designed only to study whether the ductus itself closed following treatment and not to determine if there was an improvement in mortality risk or in respiratory outcomes following NSAID treatment. Given the difficulty of conducting randomized trials in preterm infants and the urgent need for practicing clinician's to know whether treatment of PDA in all preterm infants is beneficial, we used a study design that incorporated the naturally occurring practice variation in NSAID treatment for PDA as a mechanism to reduce the risk of biases that are commonly found in non-randomized investigations. This is based on the premise that if NSAID treatment for PDA in preterm infants is truly effective, we should expect to see improved mortality and respiratory outcomes in instances when clinician preference-based NSAID administration rates are higher.
Author Interviews, Cancer Research, JAMA, Prostate Cancer / 03.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30832" align="alignleft" width="131"]Dr. Jim C. Hu MD MPH Professor of Urology Weill Cornell Medicine Dr. Jim Hu[/caption] Dr. Jim C. Hu MD MPH Professor of Urology Weill Cornell Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The most significant finding from our population based study is that after years of decline following the introduction of PSA screening, we see a rise in the incidence of metastatic prostate cancer at diagnosis among men aged 75 years and older. This is concerning in light of recent criticisms and guidelines against PSA testing. For instance, in 2008, the US Preventative Services Task Force recommended against PSA testing in this age group, and in our study, we see the incidence of metastasis at diagnosis rising in 2012 and 2013. This is significant because there is no cure for men with metastatic prostate cancer of their disease. The traditional argument against PSA screening is that it leads to over-diagnosis and over-treatment of prostate cancer. However, we currently do not have a better test for diagnosing prostate cancers before it has spread beyond the prostate and metastasized. Remarkably, when Ben Stiller shared his personal use of PSA testing in his mid to late 40's and how this led to a detection of intermediate risk prostate cancer that led him to surgery and cure, others criticized him for sharing his story.
Author Interviews, Dermatology, JAMA, Melanoma / 02.01.2017

MedicalResearch.com Interview with: Jessica S. Mounessa, BS Robert P. Dellavalle, MD, PhD, MSPH Dermatology Service, Denver Veterans Affairs Medical Center, Denver, Colorado Department of Dermatology, University of Colorado School of Medicine, Aurora MedicalResearch.com: What is the background for this study? What are the main findings? Response: Skin cancer remains the most common cancer in the U.S., despite ongoing efforts to address this major public health problem. Over 9,000 deaths occur annually, and mortality rates continue to increase faster than those associated with any other preventable cancer. Malignant melanoma, the deadliest type of skin cancer, accounts for the overwhelming majority of these deaths. Our study identified regional and state differences in the incidence and mortality rates of melanoma in the United States. We found that the Northeast, specifically New England, represents the only U.S. region in which the majority of states experienced a reduction in both incidence and death rates over the ten-year period between 2003 and 2013.
Author Interviews, Cannabis, JAMA, Pediatrics, UC Davis / 02.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30899" align="alignleft" width="115"]Magdalena Cerda, DrPH, MPH Vice Chancellor's Chair in Violence Prevention Associate Director, Violence Prevention Research Program UC Davis Violence Prevention Research Program Dr. Magdalena Cerda[/caption] Magdalena Cerda, DrPH, MPH Vice Chancellor's Chair in Violence Prevention Associate Director, Violence Prevention Research Program UC Davis Violence Prevention Research Program MedicalResearch.com: What is the background for this study? What are the main findings? Response: The potential effect of legalizing marijuana for recreational use has been a topic of considerable debate since Washington and Colorado first legalized its use for adults in 2012. Alaska, Oregon and Washington, D.C., followed suit in 2014, and voters in California, Massachusetts and Nevada approved recreational use this past November. In our study, we examined changes in perceived risk of marijuana use, and in use of marijuana among school-attending adolescents, in Washington and Colorado, following legalization of recreational marijuana use, and compared pre- to post-legalization changes in these two states to changes in the 45 contiguous US states that had not legalized recreational marijuana use. Marijuana use significantly increased and its perceived harm decreased among eighth- and 10th-graders in Washington state following enactment of recreational marijuana laws. There was no change in use or perceived harm among 12th graders or among similar grades in Colorado. In particular, the data showed that legalization of recreational marijuana use significantly reduced perceptions of marijuana’s harmfulness by 14 percent and 16 percent among eighth and 10th graders and increased their past-month marijuana use by 2 percent and 4 percent in Washington state but not in Colorado. Among states without legalized marijuana use, the perceived harmfulness also decreased by 5 percent and 7 percent for students in the two grades, but marijuana use decreased by 1.3 percent and .9 percent. Among older adolescents in Washington state and all adolescents surveyed in Colorado, there were no changes in perceived harmfulness or marijuana use in the month after legalization.
Anemia, Author Interviews, ENT, Hearing Loss, JAMA / 31.12.2016

MedicalResearch.com Interview with: Kathleen Schieffer, BS, PhD Candidate Biomedical Sciences and Clinical and Translational Science Clinical and Translational Science Fellow Hershey, PA 17033 MedicalResearch.com: What is the background for this study? Response: Hearing loss is common in the United States, with its prevalence increasing with each decade of life. Iron deficiency anemia is a common, reversible condition, associated with negative health outcomes. The inner ear is highly sensitive to ischemic damage and previous animal studies have shown that iron deficiency anemia alters the inner ear physiology. Understanding the association between iron deficiency anemia and hearing loss may open new possibilities for treatment.